Does Medicare Pay for In-Home Caregivers?

In-home care is usually an ideal option for people recovering from an illness or in need of continued medical therapy. Medicare can be a much-needed financial resource for patients needing in-home care. In addition, if the patients need help with personal routines like bathing, dressing, toileting, etc., due to an illness or injuries, home health professionals can provide such help. 

Medicare will even pay for in-home caregivers to provide such services if the eligible patient receives skilled nursing or therapy at the same time as they receive the services.

Medicare for home health care only applies when a Medicare-certified home health agency provides the service. Patients who receive in-home care services from a noncertified home health agency will need to pay for all the services out of pocket. In this regard, the importance of choosing the right home care agency cannot be overstated. 

Medicare Part A And Part B For in Home Care

Beneficiaries qualify for home health care under Medicare Part A and part B. These cover varying aspects of home healthcare, with part A covering rehabilitation therapy and skilled nursing care. On the other hand, Part B covers medical equipment and necessary supplies for home care. 

Eligibility Criteria

If you qualify for home health care services, Medicare covers the following services:

  • Skilled nursing services
  • Skilled therapy services 
  • Home health aide 
  • Medical social services
  • Medical supplies 
  • Durable medical equipment (DME)

There is a profound distinction between medically necessary home care and personal care services given by unskilled caregivers. Medicare can only cover home health care services recommended by a doctor and provided by a skilled and qualified caregiver. In addition, the patient must satisfy specific eligibility requirements. How long Medicare will pay for home health care for eligible beneficiaries depends on whether they will remain eligible. 

The home care needed by a beneficiary must be less than 7 days a week or less than 8 hours a day over a period of 21 days. In addition, home care services must be deemed reasonable and essential for the treatment of specific illnesses or injuries. 

When it comes to therapy services, Medicare covers various physical, speech, and occupational therapies that are reasonable and necessary for treating an illness or injury. The therapy services must be provided by or under the supervision of a licensed therapist.

Medicare for home health care

It’s important to note that services such as custodial care or extra round-the-clock care won’t be covered and must be paid for out of pocket. In some cases, Medicare for in home care will pay for short-term custodial care (100 days or less) if the care is necessary in combination with actual in-home medical care prescribed by a doctor. 

Does an eligible patient have to pay any amount for in-home care? Well, the patient may be billed, for in-home care services and supplies that are never paid for by Medicare, for example, routine foot care. In some cases, some services and supplies may be typically covered by Medicare, but the patient agrees to pay for them. Also, a beneficiary must pay 20% of the Medicare-approved amount for Medicare-covered medical equipment, such as walkers, wheelchairs, and oxygen equipment.

In such situations where Medicare covers only part of the in-home care, we recommend having supplemental insurance to help ease the burden associated with copayments, deductibles, and premiums. This is important for eligible beneficiaries, regardless of how long Medicare will pay for home health care.


How Much Does Medicare Pay for Home Health Care Per Hour?

The average cost of home health care in 2022 is $21 per hour. However, this can significantly vary depending on the state. Medicare pays the entire approved amount of all home care and caregiver costs. In this regard, you will pay $0 for receiving any of the covered services. However, the in-home care must be “part-time or intermittent.”  

How Do I Get Medicare to Pay for Home Care and Caregiver?

Before you start receiving home health care, your agency of choice should provide detailed information about how much Medicare will pay. For eligible beneficiaries, Medicare will pay the home health agency a single payment for the in-home care services you receive during a 30-day period. Payment for each period depends on conditions and care needs. Medicare only allows care from one home health agency at a time. 

Does Medicare Cover Home Health Care for Dementia?

For dementia or Alzheimer’s patients who are Medicare beneficiaries, Medicare will pay for only some of the overall care costs. Coverage for in-home care will be possible only if the doctors consider the services necessary, and the coverage will be part-time. The level of benefits depends on home health care needs. 

Does Medicare Cover Home Health Care for Cancer Patients?

Home health care may be necessary during and after cancer treatment. Patients with advanced cancer can receive much-needed hospice care in the comfort of their home, thus spending less time in the hospital. 

Medicare for in home care covers cancer patients, although it’s typically just part of the costs. The cancer patient must follow a plan of medical care authorized by a doctor and reviewed regularly. Regarding home care coverage for cancer patients, a beneficiary can choose between part A hospital insurance and Part B doctor visits and outpatient therapy. 

Final Thoughts 

Ultimately, home health care can help avoid accidents and falls, besides improving your loved one’s happiness and general well-being, among other benefits. It’s worth mentioning that various in-home care agencies provide diverse services.  

For this reason, Medicare offers a checklist of questions you can follow to help you make informed decisions regarding the best home health agency for your needs. 

Some of these questions include:

  • Is the home care agency Medicare-certified?
  • Does the home care agency offer all the services I need, including physical and occupational therapy?
  • Does the agency have any reviews from patients and their families?
  • Does your doctor know about them?
  • Does the agency fit my personal needs, such as a language barrier or physical needs?

Ideally, you want to avoid the need to pay for in-home services provided by an agency that is not Medicare-certified. 

Personalized Home Care Services

Vibrant Health Home Care serves clients throughout Tacoma, Lakewood, Fife, Fircrest, Parkland, Steilacoom, Graham, Puyallup, Spanaway, Gig Harbor, University Place, Dupont, and the surrounding cities. 

If you need our services, we will work closely with you and your doctor to set up a custom care plan, while considering all the services, treatments, and equipment you need. Contact us online for a detailed insight into our in-home care options. Or call us at 253-240-6489; we are always a phone call away!

About Author: Annet Asio-Pasquali

Annet is a Registered Nurse in the state of Washington, she holds a Bachelor's degree in nursing from Olympic College in Bremerton, WA. She is also the founder of Vibrant Health Homecare, a company that supports the elderly and individuals with various disabilities to have an enhanced quality of life. Prior to starting her agency, Annet worked as a bedside nurse at Tacoma General Hospital for 7 years.